Endotracheal tongue blade with tube guide



y 31, 1956 R. T. BARTON 2,756,742

ENDOTRACHEAL TONGUE BLADE WITH TUBE cums Filed Aug. 18, 1953 A 77'0QNE Y United States Patent END'OTRACHEAL TONGUE BIJADE WITH TUBE GUIDE Richard T. Barton, Beverly Hills, Califi, assignor to The Barton Foundation, Los Angeles, Calif., a charitable trust Application August 18, 1953, Serial No. 374,961

6 Claims. (Cl. 128-15) This invention relates to surgical instruments of the type used for depressing the tongue during extended oral inspections or operations under endotracheal anesthesia.

The invention is applicable particularly, though not limited to oral specula of a type wherein a tongue depressor blade is associated with a prop which is adapted to engage the upper jaw to prop the mouth open during the inspection or operation. Such instruments are commonly used and have been found to be quite satisfactory for simultaneously propping open the jaws and depressing the tongue while affording a fairly unobstructed access to the patients oral and pharyngeal cavities.

The primary object of the present invention is to provide a tongue depressor which, while functioning as efficiently as formerly in its tongue depressing action, affords the additional function of providing a guide through which an endotracheal tube may be passed into the trachea for anesthesia purposes, for applying suction to the trachea and bronchi, for maintaining an open breathing passage through the pharynx and trachea, etc.

I am aware that others have previously proposed to combine with a tongue depressor blade, a tube or nozzle through which fluids may be injected into or withdrawn from the patients throat. The tongue depressor blades envisioned by such prior proposals, however, have embodied a distinct increase in the obstruction of the oral cavity, over the conventional flat thin tongue depressor blade. Furthermore, such prior devices have not pro vided for insertion of an endotracheal tube to any selected depth into the trachea.

With the foregoing in mind, the present invention aims to provide a device of the character described, which is designed to afford a minimum of obstruction to the view into the oral cavity or to the manipulation of surgical instruments therein or adjacent to the cavity.

A further object of the invention is to provide a device which will hold an endotracheal tube in a position of minimum obstruction of the oral cavity while accommodating the extension of the tube through the mouth and into the trachea; and which will prevent the tube from slipping out of the trachea.

Other objects will become apparent in the ensuing specifications and appended drawings in which:

Fig. 1 is a front view of an oral speculum instrument embodying the invention, shown in use in a patients mouth;

Fig. 2 is a side view of the same;

Fig. 3 is a sectional view through the tongue depressor blade and endothracheal tube guide sleeve;

Fig. 4 is a transverse sectional view taken on the line 44 of Fig. 3;

Fig. 5 is a top plan view of my improved tongue depressor blade unit; and

Fig. 6 is an inverted plan view of the same, with the blade shown in transverse section.

Referring now to the drawings in detail, I have shown, as an example of a surgical instrument in which the invention may be embodied, an oral speculum assembly Patented July 31, 1956 wherein my improved tongue depressor blade unit, indicated generally at A, is associated with a holder unit which is indicated generally at B. The holder unit B, which forms no part of the present invention, may include a fiat tubular holder sleeve 10 and a jaw prop 11, the latter being in the form of a loop having a crown portion 12 to engage the upper teeth 13 of a patient 14. The holder unit B may also include a spring urged, pivoted latch element 15 to cooperate with the tongue depressor blade unit A as will presently be apparent.

The tongue depressor blade A includes a flat straight shank portion 17 which may have a series of notches 18 to engage with the jaw of latch element 15 and, at its lower end, may have a finger 20 for attachment to a suitable anchor member.

At its other end, the blade unit A has a tongue depressor blade 21 projecting transversely from shank 17 at an angle which may be approximately a right angle or slightly greater as indicated in Fig. 2. The free end 22 of tongue depressor blade 21 is curved downwardly to follow generally the vertical curvature of a patients throat. Thus the intermediate portion of the blade is arched upwardly with reference to the extremities of the blade, to form a crown (high point) 23.

The blade 21 is provided with a longitudinally extending slot 24, of generally oval shape, terminating short of the respective ends of the blade. Inset into slot 23 and suitably secured to the blade 21 around the margin of the slot 24 as by means of soldering or brazing is a cylindrical sleeve 25.

The sleeve 25 is slightly shorter than the blade 21, and the respective ends thereof project only slightly beyond the points where the bottom side of the sleeve intersects the upper surface of the blade 21. The rear end of the sleeve is bevelled, at 26, so as to approach tangency to the slope of end portion 22 of the blade, and with the forward surface of the bevel preferably rounded off to approximate parallelism to the curvature of the blade between crown 23 and rear end 22, i. e., with a radial projection above the surface of the blade which is maintained at a minimum corresponding approximately to the radial projection of the unbevelled portion of the tube immediately above the crown. At the crown 23 the sleeve is set into the blade to a depth at least half of the sleeve diameter. Thus, a very substantial percentage of the side elevational area of the sleeve 25 overlaps that of the blade 21, and the sleeve projects only slightly above the crown 23. That portion, indicated at 25', of the sleeve which projects below the blade, is readily accommodated by depression of the soft tissue along the longitudinal median axis of the patients tongue 27, where the underlying structure of the throat is of maximum yieldability. The depression of the central portion of the tongue is compensated for by a slight increase in the upward extrusion (indicated in broken lines at 27 in Fig. 4) of the lateral portions of the tongue, lying beyond the lateral margins of the blade. In the ordinary case, at the crown 23 of the blade, the upward extrusion of the lateral portions of the tongue will reach approximately the level of the upper side of tube 25 as indicated in Fig. 4, whereby all parts are maintained at roughly a common and minimum level in the areas where a surgeon may require maximum freedom from obstruction when viewing or operating upon the tonsils 28 (Fig. 1) or adjacent portions of the throat area. In this connection it may be noted that the crown 23 occurs approximately at that position in the throat cavity (front to rear) where maximum obstruction of the surgeons line of vision (indicated by arrow 29 in Fig. 3) into the pharyngeal cavity 30, normally tends to occur. Thus it is of maximum importance, in obtaining freedom of vision and access, that the overall level of the parts of the anatomy and the instrument be maintained as low as possible at this position, coincident with crown 23, as indicated by the numeral 23 in Fig. 3. The arched shape of the blade 21 is such as to best conform to the general natural longitudinal contour of the tongue and throat while obtaining maximum depression of the tongue in the critical area of normal obstruction, and thus the arrangement of the sleeve 25 with a major portion of its vertical diameter disposed below the level of the blade at this critical position, and with the radius of projection of the bevelled end face 26 above the blade between the crown 23 and the rear end 22 of the blade, restricted approximately to a dimension determined by the amount of projection of the unbevelled tube above the crown 23, obtains the advantage of maximum clearance of the throat area for vision and access into the pharyngeal cavity.

The slot 24 approaches somewhat closer to the rear end 220i blade 21 than to its forward end. This makes it possible to position the sleeve 25 with a slight rearward downward inclination, corresponding generally to the inclination of the rear portion of the patients tongue. Such inclination is related to the vertical position of the main tracheal axis of a normal person in an upright position, and is correspondingly related to the longitudinal axis of shank 17. This inclination is also related to the forward, relatively straight portion of blade 21, the sleeve axis subtending a substantial angle of downward and rearward inclination (1520) relative to such forward blade portion.

In general, the inclination is such that the longitudinal axis of sleeve 25 will be substantially tangent to crown 23. Such inclination is one of the factors which makes for minimization of obstruction of view along the normal line of sight 29, since it lowers the rear end of sleeve 25 as far as possible in the area where the throat bends sharply downwardly.

Where the end portions of sleeve 25 project wholly above the level of the blade, there is of course a greater height of obstruction above the level of the adjoining parts including the blade and the tongue. However, such obstruction cannot be avoided and is confined to the medial area, leaving unobstructed lateral areas for access to such parts as the tonsils 28. Furthermore, the invention requires the arrangement wherein the end portions of the sleeve 25 are disposed wholly above the blade, in order that an endotracheal anesthesia injection tube 31 (Fig. 3) may be freely inserted through the sleeve 25 and extended into the tracheal cavity 3th as indicated. The projecting rear end of sleeve 25 provides the proper support for tube 31 so that gravity acting thereon will cause the tube (which is of flexible material such as soft rubber or equivalent soft plastic material) to assume the proper curvature for extending freely into the tracheal cavity 30. The downward-rearward inclination of the sleeve assists in. obtaining this result, since it shortens the arc of curvature of the tube 31.

In the use of the instrument, the tongue depressor blade 21 is inserted into the mouth, the prop 11 is slid upwardly and into engagement with the upper jaw and is moved to and latched in a position propping the mouth open to the desired degree; and the finger 2i is then attached to a suitable anchoring means, such as a harness attached to the operating chair or table or the surgical coverings which may be draped across the front of the patient. An endotracheal tube 31 may then be inserted through the forward end of the sleeve 25 and as the free end of the tube emerges through the rear end of sleeve 25, gravity will cause it to sag downwardly to the proper degree of curvature to enter the trachea. In this connection, the length of blade 21 is such that the rear end 22 of the blade will normally be positioned substantially forwardly of the main axis of the pharyngeal cavity 3%, and the rear end of sleeve 25 may terminate somewhat short of the end 22 of the blade, so that the proper relationship between the rear end of sleeve 25 and cavity 30 is provided in order 4 to obtain the above indicated result of facilitating the insertion of the tube into the trachea.

Alternatively, the tube 31 may be detached from the coupler 32 by which it is normally connected to anesthesia or other apparatus, may have its rear end inserted into the trachea before the speculum instrument is applied, may have its forward end passed through sleeve 25 after the speculum is in place, and may then he re-attached to coupler 32.

I claim:

1. In a speculum for endotracheal examination and surgery: a tongue depressor blade which, in longitudinal contour, is arched upwardly intermediate its ends, said blade having therein a longitudinally extending slot, of elongated oval shape; and a substantially cylindrical sleeve seated in said slot and secured to said blade at the margin of the slot, said sleeve having end portions disposed above the upper surface of the blade and an intermediate portion projecting below the upwardly arched intermediate portion of the blade to a depth below the crown thereof, equivalent to at least half the diameter of the sleeve; said sleeve functioning as a guide for insertion of an endotracheal flexible tube into the endotracheal cavity of a patient, the end portions of said sleeve projecting beyond the ends of said slot and terminating short of the ends of said blade, and the distal end of said sleeve being bevelled so as to maintain the radial projection of said distal end of the sleeve above the blade between said crown and the rear end of the blade at a minimum corresponding approximately to the radius of projection of the unbevelled portion of the sleeve immediately above said crown.

2. A tongue depressor blade as defined in claim 1, wherein said blade has a substantially straight labial portion and said sleeve is inclined downwardly and distally with relation to said labial blade portion.

3. In a speculum for endotracheal examination and surgery: a tongue depressor blade unit including a shank adapted to assume a position generally parallel to the main axis of a patients trachea and forwardly of the patients chin; a tongue depressor blade formed integrally with the upper end of said shank and projecting distally therefrom, said blade including a relatively straight labial portion adjacent said shank, lying in a plane subtending an angle of slightly more than to the plane of the shank, including an upwardly arched intermediate portion having a crown disposed somewhat nearer the distal end of the blade than to the labial end thereof, and terminating in a distal portion which is inclined downwardly and distally at an angle of between 30 and 45 relative to the plane of the shank, said blade having therein a longitudinally ex tending slot, of elongated oval shape; and a cylindrical sleeve seated in said slot and secured to said blade at the margin of the slot, said sleeve having end portions disposed above the upper surface of the blade and an intermediate portion projecting below said crown to a depth equivalent to at least half the diameter of the sleeve, said sleeve being inclined downwardly and distally with reference to said labial blade portion at an angle such that the longitudinal axis of the tube is substantially tangent to said crown; said sleeve functioning as a guide for insertion of an endotracheal flexible tube into the endotracheal cavity of a patient.

4. In a speculum for endotracheal examination and surgery: a tongue depressor blade unit including a straight shank adapted to assume a position generally parallel to the main axis of a patients trachea and forwardly of the patients chin; a tongue depressor blade formed integrally with the upper end of said shank and projecting distally therefrom, said blade including a relatively straight labial portion adjacent said shank, lying in a plane subtending an angle of slightly more than 90 to the plane of the shank, including an upwardly arched intermediate portion having a crown disposed somewhat nearer the distal end of the blade than to the labial end thereof, and terminating in a distal portion which is inclined downwardly and rearwardly at an angle of between 30 and 45 relative to the plane of the shank, said blade having therein a longitudinally extending slot, of elr ligated oval shape; and a straight cylindrical sleeve seated in said slot and secured to said blade at the margin of the slot, said sleeve having end portions disposed above the upper surface of the blade and an intermediate portion projecting below said crown to a depth equivalent to at least half the diameter of the sleeve, said sleeve being inclined downwardly and distally with reference to said labial blade portion at an angle of between 15 and 20; said sleeve functioning a guide for insertion of an endotracheal flexible tube into the endotracheal cavity of a patient.

5. A speculum as defined in claim 3, wherein the end portions of said sleeve project beyond the ends of said slot and terminate short of the ends of said blade, and wherein the distal end of said sleeve is bevelled so as to maintain the radial projection of said distal end of the sleeve above the blade between said crown and the rear end of the blade at a minimum corresponding approximately to the radius of projection of the unbevelled portion of the sleeve immediately above said crown.

6. In a speculum for endotracheal examination and surgery: a tongue depressor blade unit including a shank adapted to assume a position generally parallel to the main axis of a patients trachea and forwardly of the patients chin; a tongue depressor blade formed integrally with the upper end of said shank and projecting distally therefrom, said blade including a relatively straight labial portion adjacent said shank projecting transversely to the plane of the shank, including an arched intermediate portion having a crown disposed somewhat nearer the distal end of the blade than to the labial end thereof, and terminating in a distal portion which is inclined downwardly and distally relative to the plane of the shank, said blade having therein a longitudinally extending slot, of elongated oval shape; and a straight cylindrical sleeve seated in said slot and secured to said blade at the margin of the slot, said sleeve having end portions disposed above the upper surface of the blade and an intermediate portion projecting below said crown to a depth equivalent to at least half the diameter of the sleeve, the labial end of said tube projecting to a greater height than the distal end, said sleeve being inclined downwardly and distally with reference to said labial blade portion at an angle such that the longitudinal axis of the tube is substantially tangent to said crown; said sleeve functioning as a guide for insertion of an endotracheal flexible tube into the endotracheal cavity of a patient.

References Cited in the file of this patent UNITED STATES PATENTS 1,613,373 Beck Ian. 4, 1927 FOREIGN PATENTS 600,771 France NOV. 20, 1925 

